Rate and timing of spontaneous resolution in a vitreomacular traction group: Should the role of watchful waiting be re-evaluated as an alternative to Ocriplasmin therapy?

Dimopoulos, Spyridon; Bartz-Schmidt, Karl-Ulrich; Gelişken, Faik; Januschowski, Kai; Ziemssen, Focke

doi:10.1136/bjophthalmol-2014-304961

Cited by 44 publications

(40 citation statements)

References 20 publications

(29 reference statements)

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“…VMT on the other hand, is always pathological, and it is best observed in its mild forms with mild metamorphopsia and good visual acuity [2,5]. Spontaneous resolution of the traction has been reported in up to 50%, with a mean follow-up of 21 months [7]. Pharmacologic vitreolysis with ocriplasmin, considered a surgical procedure [8], may be an option for resolving the traction, especially in eyes with focal VMT (<1,500 μm), with no ERM and small FTMH with traction [2,3,9,10].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Vitreomacular Interface Pathology in a Spanish Tertiary Hospital

Flores‐Moreno

Arias²,

Vidal-Martí³

et al. 2016

Ophthalmologica

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Purpose: To determine the prevalence of vitreomacular interface (VMI) pathology, using spectral-domain optical coherence tomography (SD-OCT). Methods: VMI status was classified into macular posterior vitreous detachment (PVD), focal vitreomacular adhesion (VMA; ≤1,500 μm), broad VMA (>1,500 μm), focal vitreomacular traction (VMT; ≤1,500 μm), broad VMT (>1,500 μm), full-thickness macular hole (FTMH) with the presence of VMT, and FTMH without the presence of VMT. Results: A total of 1,976 eyes were included. A nonpathologic VMI was observed in 1,875 eyes (94.8%), including 1,050 (53.1%) with PVD, 120 (6.1%) with focal VMA and 705 (35.6%) with broad VMA. A pathologic state of the VMI was diagnosed in 101 eyes (5.1%). Thirty-three eyes (1.7%) were classified as focal VMT, 29 (1.4%) as broad VMT, 39 (1.9%) as FTMH, resulting in 6 small, 12 medium and 21 large FTMHs, six eyes had VMT associated to FTMH. Conclusions: Even in a tertiary care, retinal referral practice, VMI pathology is a relatively rare condition. There was a higher prevalence in a tertiary hospital study compared to population-based studies.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Vitreomacular Interface Pathology in a Spanish Tertiary Hospital

Flores‐Moreno

Arias²,

Vidal-Martí³

et al. 2016

Ophthalmologica

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“…Eine spontane Lösung einer VMT kann nach neueren Untersuchungen mittels SD-OCT im 1. Jahr nach Diagnosestellung in 22 % der Augen und häufiger beobachtet werden [23,24]. In einer kleinen Fallserie zeigte sich von der Diagnosestellung bis zum geplanten Behandlungszeitpunkt (intravitreale Behandlung mit Ocriplasmin) in einem Zeitraum von weniger als 1 Monat bei 9 % eine spontane Lösung der VMT (l " Abb.…”

Section: Makulaforamen (Durchgreifendes Makulaforamen)unclassified

Therapie der vitreomakulären Traktion mit und ohne Makulaforamen

Maier

Abraham

Frank

et al. 2016

Klin Monatsbl Augenheilkd

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Treatment is usually indicated for symptomatic vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) and without spontaneous resolution. Ultrastructural parameters are evaluated by SD-OCT, in order to classify the vitreoretinal interface and to estimate the success rate of treatment. The resolution rate after therapy with intravitreal Jetrea® (Ocriplasmin) is high (up to 70 %) in patients with symptomatic focal vitreomacular traction (≤ 1500 µm) with or without a macular hole (≤ 250 µm) and with no epiretinal membrane (ERM), but depends on the exact baseline analysis. All other patients with idiopathic traction retinopathy should be treated by minimal invasive pars plana vitrectomy (MIVI). Vitreoretinal surgery effectively removes traction and gives a high closure rate of a full thickness macular hole (FTMH, 90 to 100 %). It is now a very safe procedure with few side effects. Despite a low risk profile (cataract, retinal tear etc.) the indication for surgery needs to take the safety profile into account. Therefore vitrectomy is only indicated in symptomatic patients complaining of blurred vision, VA reduction and metamorphopsia. Vitrectomy is also indicated in patients whose treatment by pharmacologic vitreolysis has failed.

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“…Spontaneous resolution of VMT has been reported to occur between 11-34 % in published studies. 7,[17][18][19][20][21][22][23][24] However, follow-up periods were extremely long, exceeding 2 years in some cases, with the possibility of visual decline despite successful resolution. 15,24,25 For FTMH, reported spontaneous closure rates are on average much lower (3-11 %).…”

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confidence: 99%

Ocriplasmin Efficacy – An Analysis of Real-World Results From 2013 to 2015

Kuppermann¹

2015

European Ophthalmic Review

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As the eye ages, physiological events predispose it to posterior vitreous detachment. This normal ageing process can be complicated by persistent vitreomacular adhesion, which may develop into vitreomacular traction (VMT) accompanied by visual symptoms if forces are great enough to cause macular anatomical changes. Ocriplasmin represents a pharmacological treatment option for VMT resolution.The results of studies and cases reporting ocriplasmin treatment subsequent to US Food and Drug Administration (FDA) approval are presented. Analysis of 26 studies showed that 23 (88 %) reported VMT resolution efficacy results above 40 %, well higher than the 26.5 % efficacy reported in the two pivotal clinical trials. Subsequent analysis revealed patient baseline characteristics predicted to have higher VMT resolution. These clinical trial results were confirmed in 14 post-approval studies with subgroup analysis, consistently showing that patients with specific criteria had higher resolution than their non-criteria-matching counterparts. Visual acuity (VA) group averages were reported by 13 of 18 studies, with 12 (92 %) reporting VA improvement. Case reports of patients receiving ocriplasmin showed 10 of 15 (67 %) with VA improvement; the five cases reporting visual decline reported relatively short follow-up periods. A full understanding of ocriplasmin efficacy in clinical settings will help further identify ideal candidates for ocriplasmin treatment. An important advance in the understanding and treatment of VMT and FTMH was the development of optical coherence tomography (OCT) technology. OCT provides the basis for greater visualisation of vitreomacular anatomy and has allowed for standardisation in the definitions of VMA, This in turn has provided a more accurate understanding of both retinal anatomy and the pathophysiological processes of VMT and FTMH. 2 The importance of this technology is underscored by the fact that focal VMA can be first discovered on routine examination using OCT. 5,6,8,16 This provides an opportunity to appropriately manage these cases and follow them properly, and to make a decision on when and how to intervene. Use of OCT and standardisation of definitions and treatment algorithms will aid in the development and timing of appropriate treatments.

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Rate and timing of spontaneous resolution in a vitreomacular traction group: Should the role of watchful waiting be re-evaluated as an alternative to Ocriplasmin therapy?

Abstract: A shorter follow-up might underestimate the incidence of spontaneous VMT resolution as the functional outcome of watchful waiting. The likelihood of resolution does not seem to decrease after 12 months.

Cited by 44 publications

References 20 publications

The Prevalence of Vitreomacular Interface Pathology in a Spanish Tertiary Hospital

The Prevalence of Vitreomacular Interface Pathology in a Spanish Tertiary Hospital

Therapie der vitreomakulären Traktion mit und ohne Makulaforamen

Ocriplasmin Efficacy – An Analysis of Real-World Results From 2013 to 2015

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